The philtrum of the upper lip is important to the facial contour and general appearance of individuals. In patients who have undergone cleft lip surgery, reconstruction of the philtrum is important in restoring the normal appearance of the upper lip and it also helps in diverting people`s attention away from the surgical scar. Several methods of philtral dimple creation have been used, but the postoperative results have not always been satisfactory. Between 1991 and 1997, reconstruction of the philtrum with unilateral cleft nasal deformity was performed in 43 patients, transposing the orbicularis oris muscle of the central upper lip to the depressed alar base. Using this method, efforts were made to achieve reconstruction of the philtrum and correction of alar base depression simultaneously. The results were rated good to excellent by a panel of judges using the ordinary scale method. Although reconstruction of the philtral dimple and correction of the depressed alar base were very successful, reconstruction of philtral column(especially the upper portion) was not satisfactory. Therefore, other procedures such as temporal fascial grafts in the upper portion of the philtral column should also be considered at the time of primary surgery or revisional surgery.
Cicatrix ; Cleft Lip* ; Congenital Abnormalities ; Depression* ; Humans ; Lip ; Transplants

A retrospective study was performed on 64 patients who underwent orbital blow-out fracture reconstruction with autogenous or Medpor implant following blunt facial trauma between 1992 and 1997. Hospital records were reviewed especially for preoperative and postoperative diplopia, enopthalmos and extraocular muscle movement limitations between the autogenous material group and Medpor implant group. The autogenous material used was mostly conchal cartilage graft. The average follow-up period was 36 months with a range of 5 to 64 months. There was no significant statistical difference between both groups on incidence of postoperative complications of diplopia, enophthalmos and extraocular muscle movement limitations. Postoperative infection, ectropion, implant extrusion and migration were absent in both groups. The use of Medpor implant for orbital blow-out fracture reconstruction was associated with a low incidence of complication. In addition, the Medpor implant is readily available, easy to use, cut, contour, position, fixate and has no potential for graft resorption, and precludes the need to harvest an autogeneous graft. In conclusion, Medpor is a stable and reliable substitute for autogeneous graft reconstruction of the orbital blow-out fracture.
Cartilage ; Diplopia ; Ectropion ; Enophthalmos ; Follow-Up Studies ; Hospital Records ; Humans ; Incidence ; Orbit* ; Orbital Fractures ; Polyethylene* ; Postoperative Complications ; Retrospective Studies ; Transplants

Osseointegrated alloplastic ear reconstruction has revolutionized ear prosthetic retention. In this report, we evaluate the results of indirect osseointegration using the Epitec system and discuss the degree of the most serious side effect of this system, the adverse skin reactions close to osseointegrated implant post. During a three year period, Osseointegrated prosthetic ear reconstruction was performed to twenty eight patients with microtia(n = 25) and traumatic ear loss(n = 3), 22 males and 6 females aged from 6 to 43 years(mean 18.2 years). The patients, including 12 children, were treated with 58 titanium implant posts of Epitec system. These were inserted into a 3-dimensional carrier-plate which were fixed to the mastoid process with 7 to 12(mean 9.2) screws. Each patient was operated in a one-stage procedure. Two months of osseointegration of the screws was followed by fabrication of the ear prostheses. All implants were stable after follow-up at 20 to 31 months(mean 24.6 months). Fifty four of the 58 implants showed no sign of skin reactions (93.1 percent: 83.3 percent for children; 100 percent for adult). Hypertrophy of soft tissue surrounding the implants were observed only in children(2 out of 12 treated children) and did not recur after subcutaneous reduction and compressive dressing.In adults, the results of the Epitec system are very satisfactory. Use of the Epitec system in children is also promising because hypertrophy of soft tissue surrounding the implants are successfully managed. In addition, the 3-dimensional carrier-plate is well osseointegrated with bone screws and stability of the carrier-plate is reinforced by osseous covering of the thin bars of the carrier-plate by appositional bone growth of the skull.
Adult ; Bone Development ; Bone Screws ; Child ; Ear* ; Female ; Follow-Up Studies ; Humans ; Hypertrophy ; Male ; Mastoid ; Osseointegration* ; Prostheses and Implants* ; Skin ; Skull ; Titanium

No abstract available.
Transplants*

The nasal tip of the Asian is characterized by a bulbous appearance due to thick and tense skin. flaring of nostrils, and a short nasal tip projection due to underdevelopment of alar cartilages and retruded columella. Conventional augmentation rhinoplasty using silicone implant which has been routinely performed at the Asian nose has its limitations. Over the past 2 years, a total 33 patients, aged 19 to 47 years(mean 29 years) underwent open rhinoplasty to correct columellar retraction, to lengthen the nose and to improve the appearance of the nasal tip using columellar strut in conjunction with augmentation with silicone dorsal implant. The columellar strut for control of columellar shape is optimally constructed from 0.85 mm thickness porous polyethylene(Medpor)sheet. The columellar strut is placed between the medical crura and fixed to the caudal septum. With the strut stabilized, each medial crus is advanced to the desired position. The fixation sutures are placed at 3 points: the dormal segment of the middle crus, the junction of the middle and medial crus, and the junction of the columellar segment and the footplate segment of the medial crus of the alar cartilage. Twenty-five surface measurements based on the works of Farkas included 9 singles and 5 paired lengths, and 3 angles indirectly taken from the surface of the nasal stone model. The preoperative measurements were compared with those of the postoperative. The mean follow up period was 17 months(15-24 months). The analysis of the results was conducted using Wilcoxan matched-pairs signed-ranks test.The nose length, the nasal tip protrusion, the alar length, the alar half arc, the columellar length, the nostril length, and the alar rim-columellar length were significantly increased. The intercanthal distance, the nose width, the nostril width, and the upper lip length were significantly decreased. The nasolabial angle was also significantly increased. Good to excellent asethetic results were noted in all patient, although one patient did experience mild deviation of a columella. No extrusions occurred. Using the control columellar polyethlene strut, the retracted columella was advanced, the tip was projected, the nose was lengthened, and the nostril were narrowed and elongated. This technique is valuable in the rhinoplasty patient was has retracted columellar, short nose and long upper lip.
Asian Continental Ancestry Group ; Cartilage ; Follow-Up Studies ; Humans ; Lip ; Nose ; Polyethylene* ; Rhinoplasty ; Silicones* ; Skin ; Sutures ; Transcutaneous Electric Nerve Stimulation

Numerous surgical procedures have been advocated to correct the facial deformity in patients with hemifacial microsomia, including chondrocostal grafts, mandibular osteotomies combined with bone grafts, and maxillary osteotomies done at an early age after permanent dentition is completed. The standard treatment of these malformations consists of the application of bone grafts which can lead to unpredictable growth. Furthermore, these procedures often require intermaxillary fixation, blood transfusions and sometimes tracheostomies. Lengthening of the mandible by gradual distraction, according to the method of Ilizarov, opens new perspectives for interceptive therapy. Laboratory and clinical studies have shown that mandibular distraction is an effective and powerful reconstructive surgical technique. Lengthening of the mandible by gradual distraction was performed on five patients of hemifacial microsomia and one patient of Goldenhar syndrome using unidirectional or bidirectional extraoral device and intraoral device. In two patinets, simultaneous mandibular and maxillary distraction was performed with incomplete Le Fort I osteotomy. The amount of mandibular bone lengthening ranged from 8 to 21 mm, the patinets were maintained in fixation for an average of 12 weeks to allow ossification. There was no severe perioperative complication and the length of clinical follow-up ranged from 3 to 17 months. The skeletal change resulting from directional bone lengthening could be seen best by comparing the pre-and postoperative 3-D CT scans. There was also the potential for improvement in neuromuscular function (functional matrix), attendant growth and development of the affected jaw. Mandibular distraction is a simple procedure with minimal morbity and complications, so the results to date indicated that the technique can be applied to the correction of hemifacial microsomia. The development of new devices should permit multidirectional mandibular distraction and craniofacial distraction to allow early reconstruction of cranio-maxillofacial malformations. Distraction osteogenesis for reconstruction of the mandible in this subest of young patients was a safe and effective technique for improving the craniofacial skeletal form and appearance, with minimal associated morbidity.
Blood Transfusion ; Bone Lengthening ; Congenital Abnormalities ; Dentition, Permanent ; Follow-Up Studies ; Goldenhar Syndrome* ; Growth and Development ; Humans ; Jaw ; Mandible ; Mandibular Osteotomy ; Maxillary Osteotomy ; Osteogenesis, Distraction ; Osteotomy ; Tomography, X-Ray Computed ; Tracheostomy ; Transplants

Hemifacial microsomia is a condition most frequently associated with facial asymmetry. Authors have experienced eighteen patients with mild hemifacial microsomia who were classified as type IA and IB. For the correction of mandibular asymmetry, mandibular augmentation was performed on the mandibular angle of the affected side using mandibule shaped porous high-density polyethylene(Medpor(R)) in thirteen patients. Reduction mandibuloplasty was performed on the mandibular angle of the normal side using lateral cortectomy in four patients, and genioplasties were used in 2 patients. Osseous genioplasty(n=10), buccal fat removal(n=4), augmentation rhinoplasty(n=2), and onlay bone graft(n=1) as ancillary procedures were simultaneously executed. Except for 4 patients in whom the implants were removed due to exposure and infection, all other patients were satisfied with a more symmetric contour of their face. The results were clinically evaluated through ordinary scale method and photogrammetric analysis. The mean score was rated 'good' as 12.5 points, and the mean bigonial distance index and the mean gonion-midsagittal distance index were 105.20%(p=0.035) and 100.65%(p=0.368), respectively, which meant a more symmetry of the lower face. In minor asymmetry of the mandible in cases of hemifacial microsomia, augmentation with cautions of the affected side, reduction with lateral cortectomy of the mandible in the non-affected side, and an even osseous genioplasty can provide the patient with a more symmetric lower face.
Facial Asymmetry ; Genioplasty* ; Goldenhar Syndrome* ; Humans ; Inlays ; Mandible ; Polyethylene*

For decades, many surgical techniques have been devised for correction of the gummy smile including mucosal resection, myectomy, the implant spacer technique, and osseous shortening of the alveolar-maxillary complex in case of vertical maxillary excess. However there are several problems in those techniques: the mucosal resection and the myectomy tends to recur, there would be the morbidity of the implant in the implant spacer technique, and the osseous shortening of the alveolar-maxillary complex is a procedure for the long face syndrome. Our technique is freeing the levator labii suprioris muscles and cinching them to the anteroinferior nasal septal cartilage for loss of muscle action. Seventeen patients(14 females and 3 males; mean age, 24 years) underwent operations. Preoperative photogrammetric analysis indicated the range of gum exposure when smiling was 2.0 - 9.0 mm(mean, 3.8 mm) and the maxillary lip length in repose was 17.0 - 29.0 mm(mean, 23.1 mm). Three to 31 months(mean, 12 months) after the operation, the results were analysed using the Wilcoxon signed ranks test. The postoperative gum exposure was ranged 0.0 - 4.0 mm(mean, 0.4 mm) (-3.4 mm, p< 0.05). And the maxillary lip length was elongated about 4%(+1.0 mm, p< 0.05). Results were also analyzed clinically by the ordinary scale method. The gum exposure when smiling was excellent and the nature of the smile was good. Upper lip stiffness developed in all patients, but resolved completely within 1 month after the operatio. Hypesthesia of the upper lip was noted in 8 cases, but also disappeared within 2 months. Additionally, this technique resulted in narrowing of the interalar distance. Our technique is effective in correcting a gummy smile, but would not be recommended for patients with an abnormally narrow interalar distance.
Cartilage ; Elevators and Escalators* ; Female ; Gingiva ; Humans ; Hypesthesia ; Lip* ; Male ; Muscles ; Smiling

Lately, both the frontalis muscle flap transposition and the frontalis myofascial advancement flap have been used mainly for the correction of blepharoptosis with poor levator function. Therefore, the purpose of this study is to know the functional differences of these two methods by objective method. During the past 16 years, the 43 patients, aged 5 to 68 years(mean 32.4 years) have been undergone the tripartite frontalis muscle flap transposition(unilateral 16 patients; bilatral 12 patients, 24 eyelids) and the frontalis myofascial advancement flap(unilateral 8 patients; bilateral 7 patients, 14 eyelids). To compare these two methods, this study was done with the anthropometry using photogrammetric analysis with an average follow-up of 5.5 years. Ptosis ratio on the primary gaze and the upward gaze, and the height of palpebral fissure on the downward gaze and the closing eyes were measured. The results were statistically analysed using Wilcoxon signed ranks test. In conclusion, there is no difference on the primary gaze, the downward gaze, and the closing eyes between the tripartite frontalis muscle flap transposition and the frontalis myofascial advancement flap, but ptosis degree on the upward gaze was less severe in the tripartite frontalis muscle flap transposition. This difference may result from disparity in contractile power of the frontalis muscle due to not only anatomical structure but also size of the flap. Second, the orbicularis oculi muscle is atropied by denervation of the temporal branch of the facial nerve in frontalis myofascial advancement flap.
Anthropometry ; Blepharoptosis* ; Denervation ; Facial Nerve ; Follow-Up Studies ; Humans

Numerous choices exist for closing any wound, so the surgical challenge is that of selecting the optimal method. It is necessary to balance multiple factors, including recipient site requirements, donor site morbidity, operative complexity, and patient factors. Limiting the donor site morbidity is emphasized in the aphorism "Never rob Peter to pay Paul unless Peter can afford it. Certainly, documented cases exist in which donor site morbidity exceeds the original recipient problem, necessitating a second procedure to reconstruct the donor site. The flap survived and the wound was closed, but the donor site was often worse than the original defect. Numerous donor site complications are often overlooked while one concentrates on the successful flap transfer. The standard method for grafting donor wound after harvesting of a flap uses thick split-thickness skin grafts. This method, however, creates an additional comlication-prone wound at the donor sites. Donor sites for grafting can be painful and may develop infection, hypertrophic scarring, blistering. The problem of donor sites scar hypertrophy occurs most frequently when a graft is taken at more than 0.012 inch thick, leaving a residual dermal bed is too thin. AlloDerm processed allograft dermis was developed as a permanent dermal transplant for full thickness wounds. Between 1997 and 1999, we have applied AlloDerm grafts and ultra-thin autografts on 11 patients with donor sites after harvesting flaps. All the composite AlloDerm /autograft were noted to be firmly adherent except 2 cases, which showed focal loss of the grafts and was healed after second graft. AlloDerm exhibited a high percentage take and supported an overlying ultra thin split-thickness skin autograft, applied simultaneously. By providing a dermal replacement, the grafted dermal matrix permitted a thin autograft from the donor site. The ultra-thin autografts leave donor sites that heal faster and with fewer complication. AlloDerm dermal transplants exhibit excellent elastisity and good pigmentation with minimal scarring or wound contracture. Sensory reinnervation after the composite AlloDerm/autograft was not fully recovered. The reason was that these grafts were placed on the bone or tendon exposed sites which were not sufficiently well- innervated graft bed. The high reproducibility of excellent results with this composite graft, coupled with the reduced trauma and rapid healing of donor sites associated with ultra-thin autograft STSG, has made composite grafting with the use of AlloDerm dermal transplants our new method of choice for treatment of donor defects of flap surgery.
Allografts* ; Autografts ; Blister ; Cicatrix ; Cicatrix, Hypertrophic ; Contracture ; Dermis ; Humans ; Hypertrophy ; Pigmentation ; Skin ; Tendons ; Tissue Donors* ; Transplants ; Wounds and Injuries