PURPOSE: Nasotracheal or oral intubation procedure is widely used for facial bone fractures. However, during the operation intubated tube can interfere or obstruct the view of the operator. We authors used a modified submental intubation method in panfacial bone fracture patients for intact airway and the operation view. METHODS: After intravenous induction of anaesthesia, traditional orotracheal tubation was done. A horizontal incision was made 2cm from the midline, 2cm medial to and parallel with the mandible in the submental region.1 In order to approach to the floor of the oral cavity, a haemostat was pushed through the soft tissues. A chest tube front cover was applied to the intubation tube and the tube was inserted through the submental tunnel. Orotracheal tube was disconnected and pulled back through the soft tissue and secured with a suture. RESULTS: The procedure took about 30 minutes and there were no problems during the intubation. Intraoral manipulation and occlusal checks were free without any interference. Extubation was also easily done without any complications such as lung aspiration, infection, hematoma, or fistula. CONCLUSION: Submental endotracheal intubation is fast, safe, easy to use and free from the concern about the tube being pull back again. Conventional submental intubations are being held without any coverage of the tip. We authors applied the modified method to the trauma patients and obtained satisfactory results. From the above advantages, modified submental intubation can be widely available not only in fractured patients, but also in aesthetic or orthognathic surgeries.
Chest Tubes ; Facial Bones ; Floors and Floorcoverings ; Fractures, Bone ; Hematoma ; Humans ; Intubation ; Intubation, Intratracheal ; Lung ; Mandible ; Mouth ; Orthognathic Surgery

PURPOSE: Vaccum-assisted closure(VAC) has rapidly evolved into a widely accepted treatment of contaminated wounds, envenomations, infiltrations, and wound complications. This results in a sealed, moist environment where tissue is given the opportunity to survive as edema is removed and perfusion is increased. Many plastic surgeons now place a VAC device directly over the fasciotomy site at the time of the initial procedure. Large amounts of the fluid are withdrawn, and fasciotomies can be closed primarily sooner. This study was designed to observe the effect of VAC in preventing complications in snake bitten hands. METHODS: In our study of three cases of snake bite, three of them underwent the VAC treatment & fasciotomy of the wound in the hand. This cases, the posterior compartment of the hand was bitten for a few days, releasing incisions were made of the posterior hand and 125mmHg of continuous vacuum was applied to fasciomy incision site and the biting wound. The dressings were changed three times per week. RESULTS: Our study examining the effects of applied vacuum in preventing snake bite wounds showed that the incidence of tissue necrosis and compartment syndrome was significantly lower for vacuum-treated wounds than for conservative wounds. Serum myoglobin, CK-MB, and CPK levels measured after fasciotomy incision were significantly decreased. We obtained satisfactory results from early dorsal fasciotomy, drainage of the edema with the VAC system, and then primary closure. The postoperative course was uneventful. CONCLUSION: Envenomation is a term implying that sufficient venom has been introduced into the body to cause either local signs at the site of the bite and/or systemic signs. Use of the vacuum-assisted closure device in snake bite can result in a decreased rate of tissue necrosis, lymphatic fluid collection, hemolytic fluid collection, and edema. Early fasciotomy of the dorsal hand and VAC apply is the alternative treatment of the snake bite.
Bandages ; Bites and Stings ; Compartment Syndromes ; Drainage ; Edema ; Hand ; Hypogonadism ; Incidence ; Mitochondrial Diseases ; Myoglobin ; Necrosis ; Negative-Pressure Wound Therapy ; Ophthalmoplegia ; Perfusion ; Snake Bites ; Snakes ; Vacuum ; Venoms

PURPOSE: Carpal tunnel syndrome is the most common peripheral compressive neuropathy. Most cases are idiopathic, but rarely carpal tunnel syndrome can be associated with a ganglionic mass. We report our recently encountered experience of surgical treatment of carpal tunnel syndrome caused by a simple ganglionic mass. METHODS: A 53-year-old man presented with chief complaints of numbness and hypoesthesia of his left palm, thumb, index finger, long finger, and ring finger of one and half month duration. Physical examination revealed positive Tinnel's sign without previous trauma, infection or any other events. Electromyography showed entrapment neuropathy of the median nerve. Magnetic resonance imaging(MRI) showed an approximately 2.0cm-sized mass below the transverse carpal ligament. Upon surgical excision, a 1 x 1.5cm2 mass attached to the perineurium of the median nerve and synovial sheath of the flexor digitorum superficialis and redness and hypertrophy of the median nerve were discovered. With surgical intervention, we completely removed the ganglionic mass and performed surgical release of the transverse carpal ligament. RESULTS: The pathology report confirmed the mass to be a ganglion. The patient exhibited post-operative improvement of his symptoms and did not show any complications. CONCLUSION: We present a review of our experience with this rare case of carpal tunnel syndrome caused by a ganglionic mass and give a detailed follow-up on the patient treated by surgical exploration with carpal tunnel release.
Carpal Tunnel Syndrome ; Electromyography ; Fingers ; Follow-Up Studies ; Ganglion Cysts ; Humans ; Hypertrophy ; Hypesthesia ; Ligaments ; Magnetic Resonance Spectroscopy ; Median Nerve ; Middle Aged ; Nerve Compression Syndromes ; Peripheral Nerves ; Physical Examination ; Thumb

PURPOSE: Accessory tragus is a fairly common congenital malformation and usually located at pretragal area. Surgical removal is a common treatment of accessory tragus irrespective of location and morphology. Most accessory tragi do not have depression site around them, but some do. So in those cases, simple surgical excision was not enough to promote the aesthetic facial appearance. For depression site remodeling, the excess amount of skin and cartilage need to be remained partially instead of total excision. This method can achieve the symmetric contour of pretragal area. The authors excised the epidermis and cartilaginous tissue totally and remained the dermis for reconstruction of the depression site around accessory tragus. The depression site is filled with dermal turnover flap. The purpose of this report is to present new idea to promote cosmetic result in treatment of accessory tragus containing the depression site. METHODS: Two patients had a pair of accessory tragi at pretragal area. One was a common featured accessory tragus, but the other was different. Depression site was found around accessory tragus. After epidermis and cartilaginous tissue were removed from it, dermis component was used as turnover flap for reconstruction of depression site. RESULTS: After accessory tragus was removed and depression site was reconstructed, facial contour and cosmetic result was achieved. Complication such as flap necrosis and wound dehiscence was not observed. CONCLUSION: The accessory tragus has variant morphology and degree of invasive depth. And some has a depression site around them. In those cases, simple surgical removal results in morphological distorsion and do not promote facial symmetry. The authors suggest dermal turnover flap as reconstruction method of the depression site. This method improves both surgical outcome and cosmetic result.
Cartilage ; Cosmetics ; Depression ; Dermis ; Epidermis ; Humans ; Necrosis ; Skin

PURPOSE: Lymphedema of the scrotum and penis is a functionally and emotionally incapacitating problem for patients. Patients suffer pain from swelling, chronic irritation, repeated infections, drainage, and sexual dysfunction. Although there are various methods for the treatment of scrotal and penial lymphedema, achieving a satisfactory reconstruction in severe cases still remains a challenge due to the lack of locally available tissue. METHODS: A 33-year-old man sustained severe lymphedema of the scrotum and penis. He reported a history of swelling since 25 years, which had been intensified during the past few months. There was no history of irritation, surgery, trauma, infection or travel to endemic countries. The authors reconstructed the scrotum and penis using 4 scrotal flaps made by incising the enlarged scrotum crucially. RESULTS: The postoperative course was uneventful. Histopathologic examination showed nonspecific chronic inflammation. The patient was followed up for 18 months and a good reconstructive result was obtained with no recurrence. CONCLUSION: The authors' method is safe and easy to perform. This method may be a convenient and reliable alternative for the treatment of severe lymphedema of the scrotum and penis.
Adult ; Drainage ; Humans ; Inflammation ; Lymphedema ; Male ; Penis ; Scrotum

PURPOSE: Coverage of full-thickness large flank defect is a challenging procedure for plastic surgeons. Some authors have reported external oblique turnover muscle flap with skin grafting, inferiorly based rectus abdominis musculocutaneous flap, and two independent pedicled perforator flaps for flank reconstruction. But these flaps can cover only certain portions of the flank and may not be helpful for larger or more lateral defects. We report a case of large flank defect after resection of extraskeletal Ewing's sarcoma which is successfully reconstructed with reverse latissimus dorsi myocutaneous flap. METHODS: A 24-year-old male patient had 13.0x7.0x14.0cm sized Ewing's sarcoma on his right flank area. Department of chest surgery and general surgery operation team resected the mass with 5.0cm safety margin. Tenth, eleventh and twelfth ribs, latissimus dorsi muscle, internal and external oblique muscles and peritoneum were partially resected. The peritoneal defect was repaired with double layer of Prolene mesh by general surgeons. 24x25cm sized soft tissue defect was noted and the authors designed reverse latissimus dorsi myocutaneous flap with 2110cm sized skin island on right back area. To achieve sufficient arc of rotation, the cephalic border of the origin of latissimus dorsi muscle was divided, and during this procedure, ninth intercostal vessels were also divided. The thoracodorsal vessels were ligated for 15 minutes before divided to validate sufficient vascular supply of the flap by intercostal arteries. RESULTS: Mild congestion was found on distal portion of the skin island on the next day of operation but improved in two days with conservative management. Stitches were removed in postoperative 3 weeks. The flap was totally viable. CONCLUSION: The authors reconstructed large soft tissue defect on right flank area successfully with reverse latissimus dorsi myocutaneous flap even though ninth intercostal vessel that partially nourishes the flap was divided. The reverse latissimus dorsi myocutaneous flap can be used for coverage of large soft tissue defects on flank area as well as lower back area.
Estrogens, Conjugated (USP) ; Glycosaminoglycans ; Humans ; Male ; Muscles ; Perforator Flap ; Peritoneum ; Polypropylenes ; Rectus Abdominis ; Ribs ; Sarcoma, Ewing ; Skin ; Skin Transplantation ; Thorax ; Young Adult

PURPOSE: Schwannoma is a slow-growing, encapsulated benign peripheral nerve tumor that originates from the Schwann cell of the nerve sheath. Schwannoma most frequently involves the major nerve. Schwannoma of the foot is rare. This is a report of our experience with a small, deep-seated, and non-palpable schwannoma occurring in the foot. METHODS: A 42-year-old woman presented with the plantar pain of the right foot during 2 years. Physical examination did not identified a palpable mass. She made a clinical diagnosis of plantar fasciitis and was conservatively treated 2 years ago. Since her plantar foot pain was aggravated, she was recently visited again. For the evaluation of her plantar foot pain, sonographic examination of the whole right foot was performed, and it revealed a small hypoechoic hetergenous, deep-seated mass beneath the plantar aponeurosis. At operation, a 0.7x0.6x0.4cm sized, ovoid, yellowish grey mass was removed. RESULTS: Histology was confirmed that the mass was a benign schwannoma. There were no postoperative complications. CONCLUSION: Unsusual case of a schwannoma with the plantar foot pain during 2 years is presented. It should be recognized a small, deep-seated, non-palpable schwannoma as a possible cause of plantar foot pain.
Adult ; Fasciitis, Plantar ; Female ; Foot ; Humans ; Neurilemmoma ; Peripheral Nervous System Neoplasms ; Physical Examination

PURPOSE: Malignant peripheral nerve sheath tumor without neurofibromatosis type 1 is very rare neoplasm. Development in the superficial soft tissue is exremely rare. Authors experienced one rare case of primary malignant peripheral nerve sheath tumor developed on abdomen. The clinical and histologic findings were described. METHODS: An 83-year-old man visited hospital with an 11x6.5x4.5 cm sized ulcerated and hemorrhagic mass on abdomen. The tumor was localized in abdominal skin and started growing 3 years ago. RESULTS: Wide excision with safety margin of 2cm and limberg flap was done. The postoperative biopsy revealed a malignant peripheral nerve sheath tumor. There was no evidence of recurrence of tumor for 16 months. CONCLUSION: Malignant peripheral nerve sheath tumor is an aggressive malignant tumor. An abrupt enlargement of size, ulceration and bleeding are suggestive of malignant chnages of the tumor. We recommand early wide excision with enough safety margin as treatment of malignant peripheral nerve sheath tumor.
Abdomen ; Aged, 80 and over ; Biopsy ; Hemorrhage ; Humans ; Neurofibromatosis 1 ; Peripheral Nerves ; Recurrence ; Skin ; Ulcer

PURPOSE: Nevus sebaceus is a congenital hamartomatous lesion, typically involving head and neck. Various benign and malignant neoplasms can develop in association with nevus sebaceus. We report a case of simultaneous occurrence of squamous cell carcinoma and basal cell carcinoma in nevus sebaceus. METHODS: A 73-year-old man presented with erythematous to black verrucous nodules on the right subauricular area. The upper part was accompanied with inflammation and ulceration, and no specific findings suspicious for malignant degeneration were found in the lower part preoperatively. The mass was totally excised and the defect was directly closed. Lymph nodes were not involved on concomitant neck dissection. RESULTS: Histopathologic examination confirmed the presence of squamous cell carcinoma in the upper part and basal cell carcinoma in the lower part of a nevus sebaceus. Negative margins were achieved on resection. No clinical problems were found during the 3-month follow-up period. CONCLUSION: We experienced a rare case of simultaneous occurrence of squamous cell carcinoma and basal cell carcinoma within the same nevus sebaceus. Because patients with nevus sebaceus have risk of malignant changes, surgical excision and work-up for recurrence and metastasis should be considered in suspicious cases. And even in a totally asymptomatic case, the possibility of occult secondary cancer should be informed before surgery in aged patients.
Aged ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Follow-Up Studies ; Head ; Humans ; Inflammation ; Lymph Nodes ; Neck ; Neoplasm Metastasis ; Nevus ; Recurrence ; Ulcer

PURPOSE: Superior orbital fissure syndrome is a rare neurological complex. Superior orbital fissure syndrome may result from a variety of inflammatory, infectious, neoplastic, iatrogenic, traumatic, vascular cause. The author report a patient who suffered from superior orbital fissure syndrome after inferior orbital wall reduction. METHODS: A 26-year-old female suffered from inferior orbital wall fracture with inferior gaze limitation and orbital soft tissue herniation. On posttrauma 10 day, inferior orbital wall was reduced using endoscope and porous polyethylene(Medpor(R)) was inserted. On immediate postoperation, she reported that extraocular movement was limited in almost any directions. She underwent exploration surgery to release the presence of extraocular muscle impingement. But, there was no observation of extraocular muscle impingement. On postoperative one day, high- dose steroid therapy was started to release superior orbital fissure syndrome which was defined in postoperative computed tomography. RESULTS: After one month of high-dose steroid therapy, extraocular movement limitations improved progressively in all directions. In four months, extraocular movement recovered completely. CONCLUSION: Superior orbital fissure syndrome may occur after surgical procedure of orbital wall reduction. Prompt diagnosis and treatment with mega-dose corticosteroid is an effective option for avoiding disaster from compressive syndrome.
Adult ; Disasters ; Endoscopes ; Female ; Humans ; Muscles ; Orbit