PURPOSE: Dermoid cysts are benign neoplasms that are derived from both ectoderm and mesoderm. Approximately 7 percent of all dermoid cysts occur in the head and neck, as most common sites are the lateral ends of the eyebrows, the midline in the nasal root and neck. Rarely they can be found in the frontal sinus, temporal bone, maxilla and the floor of the mouth. Dermoid cysts in the temporal fossa are extremely rare. We experienced a characteristic dermoid cyst that occupied the temporal fossa. METHODS: A 16-year-old man had a progressive enlarging mass on the left eyebrow. Computerized tomographic scan showed a bulging mass in the temporal fossa, and it had the density similar to that of fat. The size of the mass was 3x3x2cm, and it was composed of high density of fat with clear margin. There was no bony invasion, but the mass was fixed on bone. RESULTS: We performed the surgery through coronal incision under general anesthesia. Because the mass was closely connected with temporal fat pads, we removed this mass with some portion of temporal fat pads, avoiding damage to the facial nerve. The postoperative course was ordinary without complication. CONCLUSION: The reports about dermoid cyst on the temporal fossa is uncommon. However, if there is a mass in the temporal fossa which has the density similar to that of fat in CT scan, we should consider the possibility of dermoid cyst. We suggest that excision through coronal incision with bewaring temporal fat pad can induce good result.
Adipose Tissue ; Adolescent ; Anesthesia, General ; Dermoid Cyst ; Ectoderm ; Eyebrows ; Facial Nerve ; Floors and Floorcoverings ; Frontal Sinus ; Head ; Humans ; Maxilla ; Mesoderm ; Mouth ; Neck ; Temporal Bone

PURPOSE: Lobular capillary hemangioma is a vascular tumor that commonly occurs as a cutaneous lesion. Intravenous pyogenic granuloma is a rare form of lobular capillary hemangioma that usually occurs in the veins of the neck and the upper extremities. METHODS: A 41-year-old man presented with 3 months history of nodules on the left temporal area and these lesions were clinically mistaken for a typical lipoma or epidermal cyst, but the nodules appeared unusually vascular with sentinel veins on excision. RESULTS: On the histopathologic examination, the excised tissue was observed as an intraluminal polypoid mass, which was attached to the vein via a fibrovascular stalk and capillaries in a loose edematous fibromyxoid stroma, and so the lesions were confirmed to be intravenous pyogenic granuloma. At 6 months after excision, there has been no recurrence and the patient is asymptomatic. CONCLUSION: Intravenous pyogenic granuloma is a rare variant of lobular capillary hemangioma. This article describes the surgical and histopathological findings of treating pyrogenic granuloma.
Adult ; Capillaries ; Epidermal Cyst ; Granuloma ; Granuloma, Pyogenic ; Humans ; Lipoma ; Neck ; Nitriles ; Pyrethrins ; Recurrence ; Upper Extremity ; Veins

PURPOSE: Sebaceous carcinoma is a rare malignant tumor that occurs mostly in head and neck regions. Early diagnosis and treatment are necessary because it tends to be locally aggressive and goes through distal metastasis with fast progression. This study presents reliable surgical methods for sebaceous carcinoma in head and neck regions. METHODS: Three patients were included in this study. First, a 61-year-old woman visited the hospital with a yellow-colored, slowly growing mass on the left ala. A 54-year-old woman had a brown-colored mass on her right preauricle. Last case was a 62-year-old man who had a yellow-colored mass on his scalp. CT scan and punch biopsy were done. All cases were diagnosed as sebaceous carcinoma. The lesions were resected with 10 mm safety margin and various regional flaps were used for reconstruction. RESULTS: Histological examination revealed sebaceous differentiation and local invasions. Postoperatively, all patients did not suffer from complication and no recurrence was found. CONCLUSION: We recommend early wide excision with an enough safety margin, and a regional flap as a treatment of sebaceous carcinoma.
Biopsy ; Early Diagnosis ; Female ; Head ; Humans ; Middle Aged ; Neck ; Neoplasm Metastasis ; Recurrence ; Scalp

PURPOSE: The radial forearm fasciocutaneous free flap is currently considered as the ideal free flap for reconstruction of mucosal and soft tissue defects of the palate. But the availability of stably attached oral and nasal mucosal lining is needed. In addition to this, for better operation field, operating convenience and esthetics, we planned a prelaminated radial forearm free flap. METHODS: A 64-year-old male patient was admitted due to a 4x4.5cm full through defect in the middle of the hard palate caused by peripheral T cell lymphoma with actinomycosis. In the first stage, the radial forearm flap was elevated, tailored to fit the hard palate defect, and then it positioned up-side down with split thickness skin graft. Two weeks later, the prelaminated radial forearm free flap was re-elevated and transferred to the palatal defect. One side covered with grafted skin was used to line the nasal cavity, and the other side(the cutaneous portion of the radial forearm flap) was used to line the oral cavity. RESULTS: The prelamination procedure was relatively easy and useful. The skin graft was well taken to the flap. After 2nd stage operation, the flap survived uneventfully. There was no prolapse of the inset flap into the oral cavity and the cutaneous portion of the flap was mucosalized. The procedure was very successful and the patient can enjoy normal rigid diet and speech. CONCLUSION: The use of prelaminated radial forearm free flap for hard palate reconstruction is an excellent method to restore oral function. Based upon the result of this case, microvascular free flap transfer with prelaminated procedure is a valid alternative to the prosthetic obturator for palatal defect that provides an improved quality of life. It should be considered as an integral component of head and neck cancer therapy and rehabilitation.
Actinomycosis ; Diet ; Esthetics ; Forearm ; Free Tissue Flaps ; Head and Neck Neoplasms ; Humans ; Lymphoma, T-Cell, Peripheral ; Male ; Middle Aged ; Mouth ; Nasal Cavity ; Palate ; Palate, Hard ; Prolapse ; Quality of Life ; Skin ; Transplants

Posttraumatic pseudoaneurysm of the superficial temporal artery is very rare and occurs secondary to trauma. Clinical diagnosis is based on past history of trauma and physical examination and can be confirmed by duplex ultrasonogram, digital subtraction angiography, CT and MRI. Ligation of proximal and distal ends of the superficial temporal artery and excision of the pseudoaneurysm has been the standard treatment. Compressive therapy, endovascular coil embolization, percutaneous thrombin injection under ultrasound guidance have been reported as alternative treatment methods. When surgical excision of the superficial temporal artery pseudoaneurysm is performed, surgeon must be concerned about the anatomical relation between superficial temporal artery and temporal branches of the facial nerve. In this article, we report a rare case of superficial temporal artery pseudoaneurysm with some review of the literatures about anatomical relation between superficial temporal artery and temporal branches of facial nerve.
Aneurysm, False ; Angiography, Digital Subtraction ; Facial Nerve ; Ligation ; Physical Examination ; Temporal Arteries ; Thrombin

PURPOSE: After surgical interventions of mandible fractures, facial asymmetry can be occurred, and it leads to serious problems for patients. This can be solved by mandible angle ostectomy. METHODS: A 19-year-old male underwent percutaneous surgical intervention for left mandibular angle and right parasymphyseal fractures 3.5 years ago. The left angle was protruded compared to the other side. Using a percutaneous approach, 4.5x1cm sized piece of mandible angle was sawed off. For the right angle, intraoral approach was performed for angle ostectomy, and the angle was sawed off by a size of 4x1cm, using a pattern based on the piece from the left side. RESULTS: After surgery, no complications such as subcondylar fractures, refractures, insufficient corrections, secondary angle formations, hematomas, and transient nerve palsies were seen, and symmetric correction of mandible angles were done. CONCLUSION: In facial asymmetries due to mandibular fractures, mandible ostectomy could be a solution. Using the bone section from the contralateral side, measurement of the amount of bone sawed off was possible, and via percutaneous approach on the previously operated site with simultaneous scar revision, and intraoral approach for the contralateral side, cosmetically satisfactory result was obtained.
Cicatrix ; Facial Asymmetry ; Hematoma ; Humans ; Male ; Mandible ; Mandibular Fractures ; Paralysis ; Young Adult

PURPOSE: The epicanthus is a specific feature in Asian. Many techniques have been described to eliminate the epicanthal fold: resection of glabellar skin, resection of medial canthal skin, V-Y advancement, V-W technique, modified Z-plasty, multiple Z-plasties, and others. The authors observed postoperative epiphora after correction of epicanthal fold by periciliary skin flap without damaging lacrimal duct. METHODS: A 19-year-old woman underwent non-incisional blepharoplasty, septorhinoplasty, and periciliary epicanthoplasty. On her history, she didn't have any symptom of epiphora preoperatively. And there was no specific complaint of epiphora during the postoperative two weeks. However epiphora got worse from one month after the surgery. She was out of this country, so the patient re-visited the clinic on the postoperative six months for this on-going symptom. On an ophthalmologic examination, patient's lacrimal duct and sac was intact but both lacrimal puncta of the patient were covered with a thin membrane. This membrane was punctuated by a 25 gauge needle and dilated with a standard dilator. RESULTS: After ophthalmologic treatment, no recurrence was observed during five weeks of follow-up periods. CONCLUSION: Both lacrimal puncta of the patient were only covered with membranes. And we could not confirm the direct relationship between periciliary epicanthoplasty and postoperative epiphora. The probable factors will be a predisposing narrowed punctum, post operative peri-punctal edema and decrease in muscular function of orbicularis oculi.
Asian Continental Ancestry Group ; Blepharoplasty ; Edema ; Female ; Follow-Up Studies ; Humans ; Lacrimal Apparatus Diseases ; Membranes ; Needles ; Recurrence ; Skin ; Young Adult

PURPOSE: Reconstruction of eyebrow defects after wide excision of the benign and malignant tumors present a cosmetic challenge to the plastic surgeon. There were several methods for reconstruction of partial eyebrow defect with local flaps except hair bearing composite graft. We introduce simple eyebrow reconstruction with bilateral advancement flap and tattooing on the idea that eyebrow tattooing is popular permanent eyebrow makeup among elderly Korean women. METHODS: The flaps were designed on both ends of the eyebrow defect along the upper and lower margin of the eyebrow. Both flaps were cut, undermined and were moved centrally to cover the defect. Both flaps were attached along the vertical suturing line. The rest of each flap was sown with dog-ears revised minimally. Scar lines would be hidden along the natural borders of the eyebrow if possible. The resulting vertical scar finally was covered with hair. After 8 months, eyebrow tattooing would be done to camouflage eyebrow shortening and scar. RESULTS: Partial eyebrow defect was reconstructed successfully with bilateral advancement flap and tattooing. The postoperative scar was inconspicuous and eyebrow looked symmetric. CONCLUSION: We recommend partial eyebrow reconstruction with bilateral advancement flap and tattooing for the elderly Korean female patients after excision of small tumor in and around eyebrow region.
Aged ; Cicatrix ; Cosmetics ; Eyebrows ; Female ; Hair ; Humans ; Tattooing ; Transplants ; Ursidae

PURPOSE: Brown's syndrome is characterized by the limited elevation in adduction from mechanical causes around the superior oblique tendon trochlea complex. In this particular case, post-traumatic facial deformity accompanied by Brown's syndrome was observed. We would like to report the satisfying cosmetic results obtained by reconstructing orbital roof and superior orbital rim and repositioning of zygoma. METHODS: A 12-year-old patient was observed with facial deformity with strabismus in her right eye and orbital dystopia after the car accident and was eventually diagnosed with traumatic Brown's syndrome. Reconstructive surgeries could not be performed at the time of trauma due to the cerebral hemorrhage. At the second year after the trauma, a depressed fracture of the right orbital roof and superior orbital rim were reconstructed via the intracranial approach, and orbital dystopia was corrected via the zygoma triple ostectomy. In addition, a strabismus surgery was performed one year after her plastic surgery. RESULTS: Facial deformity with orbital dystopia and strabismus was confirmed to be fully reconstructed after the surgery. Moreover, when the patient came in for a follow-up thirteen years after the operation, a developmental imbalance of the facial bones, diplopia, or any other surgical complications were not to be found. CONCLUSION: After the trauma, the patient with Brown's Syndrome accompanied by post-traumatic facial deformity, who went under the corrective surgeries after the meticulous examination and assessment pre-surgically, was able to acquire cosmetic satisfaction via those operations.
Cerebral Hemorrhage ; Child ; Congenital Abnormalities ; Cosmetics ; Diplopia ; Eye ; Facial Bones ; Follow-Up Studies ; Humans ; Orbit ; Porphyrins ; Strabismus ; Surgery, Plastic ; Tendons ; Zygoma

PURPOSE: In accordance with the increasing number of accidents caused by various reasons and recently developed fine diagnostic skills, the incidence of orbital blow-out fracture cases is increasing. As it causes complications, such as diplopia and enophthalmos, surgical reduction is commonly required. This article reports a retrospective series of 5 blow-out fracture cases that had unusual nerve injuries after reduction operations. We represents the clinical experiences about treatment process and follow-up. METHODS: From January 2000 to August 2009, we treated total 705 blow-out fracture patients. Among them, there were 5 patients(0.71%) who suffered from postoperative neurologic complications. In all patients, the surgery was performed with open reduction with insertion of Medpor(R). Clinical symptoms and signs were a little different from each other. RESULTS: In case 1, the diagnosis was oculomotor nerve palsy. The diagnosis of the case 2 was superior orbital fissure syndrome, case 3 was abducens nerve palsy, and case 4 was idiopathic supraorbital nerve injury. The last case 5 was diagnosed as optic neuropathy. Most of the causes were extended fracture, especially accompanied with medial and inferomedial orbital blow-out fracture. Extensive dissection and eyeball swelling, and over-retraction by assistants were also one of the causes. Immediately, we performed reexploration procedure to remove hematomas, decompress and check the incarceration. After that, we checked VEP(visual evoked potential), visual field test, electromyogram. With ophthalmologic test and follow-up CT, we can rule out the orbital apex syndrome. We gave Salon(R)(methylprednisolone, Hanlim pharmaceuticals) 500 mg twice a day for 3 days and let them bed rest. After that, we were tapering the high dose steroid with Methylon(R)(methylprednisolon 4 mg, Kunwha pharmaceuticals) 20 mg three times a day. Usually, it takes 1.2 months to recover from the nerve injury. CONCLUSION: According to the extent of nerve injury after the surgery of orbital blow-out fracture, the clinical symptoms were different. The most important point is to decide quickly whether the optic nerve injury occurred or not. Therefore, it is necess is to diagnose the nerve injury immediately, perform reexploration for decompression and use corticosteroid adequately. In other words, the early diagnosis and treatment is most important.
Abducens Nerve Diseases ; Bed Rest ; Decompression ; Diplopia ; Early Diagnosis ; Enophthalmos ; Follow-Up Studies ; Hematoma ; Humans ; Incidence ; Linear Energy Transfer ; Oculomotor Nerve Diseases ; Optic Nerve Diseases ; Optic Nerve Injuries ; Orbit ; Orbital Fractures ; Retrospective Studies ; Visual Field Tests