A case of traumatic internal carotid artery injury associated with skull base fracture, Le Fort II fracture and mandible fracture after maxillofacial blunt trauma which resulted in delayed blindness is presented. This condition would appear to be a rare consquence of maxillofacial trauma. Internal carotid artery injury including dissection is an important consequence of blunt craniomaxillofacial trauma with potentially devastating consquences. It should be emphasized that skull base fracture involving the course of the internal carotid artery provides an important clue to significant vascular injury and, when present, provides the impetus for vascular imaging study.
Blindness* ; Carotid Artery, Internal* ; Mandible ; Skull Base ; Vascular System Injuries

Sagittal synostosis is the most common isolated craniosynostosis and usually recognized in early infancy. Numerous surgical techniques including strip craniectomy, the pi procedure, subtotal calvariectomy have been used, and they are usually successful if carried out in early infancy. Unfortunately, some children with sagittal synostosis are not considered for surgical correction by the age of 2 years. From March 2001 to February 2002, we have experienced two children older than 2 years of age with sagittal synostosis, and in all cases, performed total cranial vault remodeling with minimal bony defect. Reconstruction consisted of shortening of the sagittal midline strut, barrel stave osteotomy of temporal region, and right angled Z-osteotomy of parieto-occipital region. Using right angled Z-osteotomy, we can easily reshape and fix parieto-occipital bone flap with good stability and esthetic results. We report our technique for the late correction of scaphocephaly in two children with satisfactory results
Child ; Craniosynostoses* ; Humans ; Osteotomy

Epithelioid hemangioma was firstly described by Enzinger and Weiss. It belongs to a group of unusual vascular proliferation accompanying prominent eosinophilic infiltration and synonymous with angiolymphoid hyperplasia with eosinophilia(ALHE). Histopathologically, the lesion is characterized by localized, marginated and relatively symmetrical proliferation of capillaries around a medium-sized vessel with an epithelioid hyperplasia of endothelial cell and marked infiltration of inflammatory cells, eosinophils and lymphocytes. The lesion occurs usually in the dermal and subcutaneous tissue of the head and neck area. We report a case of epithelioid hemangioma occuring on the nasal tip in a 72-years-old man. Microscopically, the lesion consisted of a proliferating vessels surrounded by inflammatory infilatration predominantly composed of eosinophils and lymphocytes. But vessels were lined by conventional-appearing endothelial cells.
Angiolymphoid Hyperplasia with Eosinophilia ; Capillaries ; Endothelial Cells ; Eosinophils ; Head ; Hemangioma* ; Hyperplasia ; Lymphocytes ; Neck ; Subcutaneous Tissue

A median cleft lip has been broadly defined as any congenital vertical cleft through the center of the upper lip. In the Tessier 0 cleft, the location of the median cleft of the upper lip has a spectrum of dysmorphic gradation. This varies from a simple central vermillion notch to a wide cleft accompanied by a bifid nose and hypertelorism. Despite its extreme variability, the median cleft is quite rare and has a reported incidence amongst cleft patients alone of 0.43 to 0.73%. We experienced two cases of incomplete median cleft lip without other craniofacial anomalies. One of them who had reverse V-shaped defect of upper vermilion and fibrous band in her oral mucosa, was corrected with orbicularis oris muscle union and Z-plasty. The other patient had triangular shaped upper lip and deficiency of vermilion. We reviewed the classifications of median cleft lip and devised new classification, so that it helps understanding of median cleft lip.
Classification* ; Cleft Lip* ; Humans ; Hypertelorism ; Incidence ; Lip ; Mouth Mucosa ; Nose

Xeroderma pigmentosum is rare autosomal recessive disease, characterized by extreme sensitivity to ultraviolet light and leading to development of multiple malignant skin tumors. Among multiple malignant skin tumors, basal cell carcinoma and squamous cell carcinoma are common. Treatments of xeroderma pigmentosum are palliative or radiation treatment, but surgical resection is necessary if xeroderma pigmentosum is transited to malignant skin tumors. We report a case of a 32-years-old female xeroderma pigmentosum patient, who developed radiation resistant basal cell carcinoma on right alar nasi. Radiaton theraphy(300cGy, fractions: 10, total dose: 3000cGy) was not effective, so surgical excision and local skin flap coverage was made and no specific wound complications occurred. During 11 months follow-up period, no evidence of recurrence was found.
Carcinoma, Basal Cell* ; Carcinoma, Squamous Cell ; Female ; Follow-Up Studies ; Humans ; Ichthyosis* ; Recurrence ; Skin ; Ultraviolet Rays ; Wounds and Injuries ; Xeroderma Pigmentosum*

Rigid fixation techniques with absorbable plates and screws are recently utilized for the repair of craniofacial skeletal injuries or congenital anomalies. But no domestic literature are presented in treatments of mandible fracture. We present our early experience of absorbable plates and screws in fixation of mandible fracture. Eleven patients underwent fixation procedures for mandible fracture with absorbable plates and screws. Intraoperative stability was satisfactory in all cases. Significant problems, such as nonunion, malunion, delayed union and malocclusion from the use of absorbable plating system were not found, but there were two cases of localized inflammation. We also experienced advantages of absorbable plating system which are biodegradation, radiolucency and enough stability for reduction state. The use of absorbable plating system would eliminate potential effects on skeletal growth- restriction in child, problems associated with long- term palpability and visibility in X-ray, and cold sensitivity caused by traditional metal plating system. There are also several disadvantages of absorbable plates and screws. This plating system takes increased operative time and needs delicate technique relative to the traditional metal plating system. Nevertheless we concluded that absorbable plates and screws are good fixatives for mandibular fracture.
Child ; Electroplating ; Fixatives ; Humans ; Inflammation ; Malocclusion ; Mandible ; Mandibular Fractures* ; Operative Time

PURPOSE: Among the materials for cranioplasty, autogenous bone is ideal because it is less susceptible to infection and has lower rates of subsequent exposure. However, the procedure is technically demanding to perform and requires a donor site. Disadvantages further exist when the defect is large and there are attendant limitations in donor site. The authors present their experience with reconstruction of large skull defect using right-angled zigzag osteotomized outer table of autogenous calvarial bone, overcoming the limitation in donor site. METHODS: From 2000 to 2006, 9 patients were retrospectively reviewed, who had undergone reconstruction with right angled zigzag osteotomized outer table of autogenous calvarial bone. RESULTS: Aesthetically satisfactory skull shape was achieved. Major complications of infection, hematoma, plate exposure, and donor site complications of dural tear with bleeding, cerebrospinal fluid leak, and meningitis were not seen. One patient had delayed wound healing and was successfully managed conservatively. CONCLUSION: Autogenous bone is the material of choice for cranioplasty, especially in complicated cases. Right angled zigzag osteotomy is a useful method in reconstruction of large skull defects with less donor site morbidity.
Cerebrospinal Fluid ; Hematoma ; Hemorrhage ; Humans ; Meningitis ; Osteotomy* ; Retrospective Studies ; Skull* ; Tears ; Tissue Donors ; Wound Healing

PURPOSE: We report a patient with DiGeorge syndrome who was later diagnosed as mild metopic synostosis and received anterior 2/3 calvarial remodeling. METHODS: A 16-month-old boy, who underwent palatoplasty for cleft palate at Chungnam National University Hospital when he was 12 months old of age, visited St. Mary's Hospital for known DiGeorge syndrome with craniosynostosis. He had growth retardation and was also diagnosed with hydronephrosis and thymic agenesis. His chromosomal study showed microdeletion of 22q11.2. On physical examination, there were parieto-occipital protrusion and bifrontotemporal narrowing. The facial bone computed tomography showed premature closure of metopic suture, orbital harlequin sign and decreased anterior cranial volume. The interorbital distance was decreased(17mm) and the cephalic index was 93%. RESULTS: After the correction of metopic synostosis by anterior 2/3 calvarial remodeling, the anterior cranial volume expanded with increased interorbital distance and decreased cephalic index. Fever and pancytopenia were noted at 1 month after the operation, and he was diagnosed as hemophagocytic lymphohistiocytosis by bone marrow study. He however, recovered after pediatric treatment. There was no other complication during the 12 month follow up period. CONCLUSION: This case presents with a rare combination of DiGeorge syndrome and metopic synostosis. When a child is diagnosed with DiGeorge syndrome soon after the birth, clinicians should keep in mind the possibility of an accompanying craniosynostosis. Other possible comorbidities should also be evaluated before the correction of craniosynostosis in patients as DiGeorge syndrome. In addition, postoperative management requires a thorough follow up by a multidisciplinary team of plastic surgeons, neurosurgeons, ophthalmologists and pediatricians.
Bone Marrow ; Child ; Cleft Palate ; Comorbidity ; Craniosynostoses ; DiGeorge Syndrome ; Facial Bones ; Fever ; Follow-Up Studies ; Humans ; Hydronephrosis ; Infant ; Lymphohistiocytosis, Hemophagocytic ; Orbit ; Pancytopenia ; Parturition ; Physical Examination ; Sutures

PURPOSE: Glomus tumor is a benign neoplasm of the normal glomus body, occurring as painful subcutaneous nodules, frequently located in the subungual area. There are few cases of facial glomus tumor reported and we report a case of glomus tumor developing on the columella of nose. METHODS: A 68-year-old female presented with a mass of the columella grown for 2 years. The nodule was 0.6 cm in diameter, red-colored without any symptoms such as pain, tenderness and cold hypersensitivity. The pathologic result after punch biopsy was hemangiopericytoma. Excision with local anesthesia was executed. RESULTS: The postoperative recovery of the patient was uneventful, Histopathological examination indicated a glomus tumor. Immunostaining revealed positivity for vimentin, actin, and negativity for desmin, CD-34. After 8 months follow up, there is neither complication nor evidence of local recurrence on clinical examination. CONCLUSION: To accomplish an accurate diagnosis of glomus tumor, the histopathological examination is essential together with immunochemical studies. The differential diagnosis include hemangioma, lipoma, epidermal inclusion cyst, dermoid cyst and arteriovenous malformation in this region. We report a case of glomus tumor on the face with uncommon clinical features.
Actins ; Aged ; Anesthesia, Local ; Arteriovenous Malformations ; Biopsy ; Cold Temperature ; Cryopyrin-Associated Periodic Syndromes ; Dermoid Cyst ; Desmin ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Glomus Tumor ; Hemangioma ; Hemangiopericytoma ; Humans ; Hypersensitivity ; Lipoma ; Recurrence ; Vimentin

Collagen is the major component of scar tissue. Considerable progress of fibroblast growth kinetics and of collagen synthesis has been achieved in the past decade. We have been interested in fibroblasts activities as they are expressed by cells cultured in collagen substrate. This study is to examine the effects of collagen substrate and peptide growth factors In culture medium on DNA and protein synthesis of human dermal fibroblasts. Collagen, interleukin-1(IL-1) and transforming growth factor-beta(TGF-beta) were added to fibroblast culture media according to the designed experiment model and DNA and protein synthesis were measured by [3H]-thymidine, [3H]-leucine, and [3H]-proline incorporation method. The morphological features of fibroblasts were observed by light microscope. The results were as follows ; 1) There were significant decreases of DNA and protein synthesis of cultured fibroblasts in the presence of collagen substrate compared with those in Control groups(p<0.01). 2) DNA and protein synthesis were decreased as dose dependant manner of collagen density in culture media. 3) Morphological features of fibroblasts became less stellate and flat, more spindle-like in the presence of collagen. 4) In responsiveness to IL-1, collagen non-treated groups responded to IL-1 but collagen treated groups were unresponsive to IL-1 (P<0.05). 5) Cells In collagen non-treated groups responded to TGF-beta as dose-related manner(P<0.01). Collagen treated groups desponded to TGF-beta but did not show TGF-beta dose-dependant relationship. In Conclusion, collagen substrate in the culture medium could lower the DNA and protein synthesis of fibroblasts. Cells in collagen substrate were unresponsive or less responsive to peptide growth factors than those in non-collagen substrate.
Cicatrix ; Collagen* ; Culture Media ; DNA* ; Fibroblasts* ; Humans ; Intercellular Signaling Peptides and Proteins ; Interleukin-1 ; Kinetics ; Transforming Growth Factor beta