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

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

PURPOSE: We assessed the clinical outcomes of a seton procedure combined with early versus late institution of infliximab (IFX) therapy. METHODS: This retrospective study comprised 76 patients who underwent surgery for perianal fistula associated with Crohn disease between January 2014 and November 2017. All patients underwent loose seton drainage combined with IFX therapy. Patients categorized as the early group (EG, 49 patients) received IFX therapy within 30 days of completion of the seton procedure. Patients categorized as the late group (LG, 27 patients) received IFX therapy >30 days after the seton procedure. IFX therapy was administered as induction and maintenance therapy. RESULTS: There were no statistically significant intergroup differences in clinical characteristics of the patients. The mean follow-up was 21.0 ± 11.6 months in the EG and 34.5 ± 18.4 months in the LG (P = 0.001). The mean interval between seton procedure and IFX induction therapy was 12.2 days in the EG and 250.2 days in the LG (P = 0.002). Complete remission was observed in 32 patients (65.3%) in the EG and 17 patients (63.0%) in the LG (P = 0.844). Fistula recurrence was observed in 6 patients (7.9%). All recurrences occurred in a previous perianal fistula tract. CONCLUSION: Patients showed a good response to a seton procedure combined with IFX therapy regardless of the time of initiation of IFX therapy.
Crohn Disease ; Drainage ; Fistula ; Follow-Up Studies ; Humans ; Infliximab ; Recurrence ; Retrospective Studies

Because medical grade silicone rubber implants are highly biocompatible, easily formable and inexpensive polymers, they are commonly used in augmentation rhinoplasty, augmentation mentoplasty and augmentation mammoplasty. Although silicone is believed to be biologically inert for a long time in the body, it can elicit calcification on the surface of the implants as it is known from experience with breast and orbital implants. However, there has been no report on calcification deposits on the surface of nasal silicone implants. Calcification on such implants was discovered during revisional rhinoplasty and the relationship between the calcified surfaces of the implants and the soft tissues surrounding the implants was studied. Nineteen implants were studied from female patients, at times ranging from 12 to 35 years after dorsal silicone implantation. To determine the rhinion's position relative to the implant, the length from the cephalic end of the implants(the 'golden point') to the rhinion was measured on 27 soft tissue profile cephalometric radiographs from the patients who had received dorsal silicone implantation in the past. This showed that the rhinion was situated at a point 42.22% along the length of the implants from the golden point. The surface of the implants was divided into four zones not only by the rhinion but also in relation to the quality of the soft tissues surrounding the implants. Zone I was the cephalic portion of the dorsal surface of the implant in contact with the periosteum. Zone II was the caudal portion of the dorsal surface in contact with the musculoaponeurotic layer. Zone III was the cephalic portion of the ventral surface in contact with the nasal bone. Zone IV was the caudal portion of the ventral surface in contact with the perichondrium. The 19 removed implants were wrapped with transparent tracing paper. The outlines of the implants and calcification areas were drawn and photographed. After placing on images of the photographs, using Adobe Photoshop version 7.0, the areas of calcification were measured. The relative area of calcification was 48.37% in zone I, 36.61% in zone II, 19.17% in zone III, and 14.33% in zone IV respectively. The calcification area of zone I was significantly greater than in other zones(zone II p<0.041; zone III p<0.002; and zone IV p<0.001) and that of zone II was greater than zone III(p<0.002) and IV(p<0.001). The relatively high degree of calcification of zone I was possibly caused by the osteogenic effect of osteoprogenitor cells in the richly vascularized periosteum. Because zone II is more mobile than the cephalic portion of the nose, increased calcification here might have been resulted from mechanical abrasion caused by movement of the muscle layer.
Breast ; Female ; Humans ; Mammaplasty ; Nasal Bone ; Nose ; Orbital Implants ; Periosteum ; Polymers ; Rhinoplasty ; Silicone Elastomers

The ultimate goal of the treatment of cleft lip and palate is the obliteration of the entire cleft early without disturbing facial bone growth. Presurgical orthopedics attempts to correct the characteristic skeletal deformities that occur in cleft lip and palate, and lip adhesion reduces the tension of the definite lip repair and allows gentle molding until the solidification of the arch occurs. Additionally lip adhesion gives a psychologic benefit to the patient's parents because of the improvement in appearance. The authors performed presurgical orthopedics and lip adhesion for 26 cases of complete unilateral cleft of primary and secondary palate between 1997 and 2001. Postoperatively, the patients are evaluated by the analysis using preoperative and postoperative dental casts. Dental cast analyses evaluate width, length, height of maxillary alveolar cleft, alveolar gap, palatal gap, and angle of arch. Results include improvement of alignment of maxillary alveolar arch and reducement of cleft gap. Also, this study of serial dental cast is the objective method to explain the corrective effect on maxillary alveolar arch in cleft lip and palate. In conclusion, presurgical orthodontics and lip adhesion achieve the main goal of moving the palate into a normal position and stabilizing the arch with a bony bridge that attracts teeth. It avoids the difficult anterior fistulae and presents a more symmetrical platform upon which the lip can be united and the nose can be corrected early. Additionally, there is a psychologic benefit to the patient's parents because of the improvement in appearance
Cleft Lip ; Congenital Abnormalities ; Facial Bones ; Fistula ; Fungi ; Humans ; Lip* ; Nose ; Orthodontics ; Orthopedics* ; Palate* ; Parents ; Tooth

The tissue deficiency in the upper lip after cleft lip repair produces a tight lip, and an Abbe flap procedure is indicated. In order to increase the mobility of the pedicle and decrease the distortion of the lips at transfer, a procedure has been developed in which the pedicle is cut all around soft tissue leaving only a inferior labial artery. Therefore, the Abbe flap which is an arterial flap has been converted to an island flap. The authors performed 15 cases(14 men and 1 woman) of the correction of a tight lip in cleft lip deformities between 1986 and 2000. The patient ranged in age from 18 years to 33 years at the time of surgery, with a mean age of 24.4 years. From 1 to 14 years(mean, 9.7 years) postoperatively, the patients were evaluated by the photogrammetric analysis using preoperative and postoperative photograph, and the ordinary scale method. By the photogrammetric analysis, the upper vermilion contour index and the lip protrusion index were measured. The upper vermilion contour index is the percentage of the surface distance of the upper vermilion ridge to the mouth width. The lip protrusion index is the percentage of the labiale superius-tragion to the labiale inferius-tragion. One represented the correction of the horizontal deficiency in the upper lip, and the other showed the protrusion of the upper lip in relation th the lower lip. By the ordinary scale method, "excellent" aesthetic results were noted. In conclusion, the Abbe island flap provides maximal flexibility without reducing its viability and an accurate adaptation in the defect of the upper lip can be made. The upper vermilion contour index and the lip protrusion index represent objectively the effects of the Abbe island flap.
Arteries ; Cleft Lip* ; Congenital Abnormalities* ; Humans ; Lip ; Male ; Mouth ; Pliability

The C749G(Pro250Arg) mutation in the gene for fibroblast growth factor receptor 3 (FGFR3) has been found in patients with various types of craniosynostosis. In this study, the blood of 9 Korean children with non-syndromic craniosynostosis were collected and mutation analyses were performed to screen whether this Pro250Arg mutation is also prevalent in Korean population. The genomic DNA samples were analysed by PCR amplification to amplify exon 7 and flanking intron sequence of FGFR3 (341 bp). Restriction digests were analysed by gel electrophoresis. There were no heterozygous for Pro250Arg mutation. No mutations in restriction enzyme digestion were confirmed by direct DNA sequencing. In this study, only 9 patients with simple craniosynostosis were subjected to mutation detection. Therefore, it is necessary to study a large number of patients in order to understand the proportion of non-syndromic craniosynostosis attributalbe to FGFR3 mutation. The epidemiologic study of this disease should be also combined in addition.
Child ; Craniosynostoses* ; Digestion ; DNA ; Electrophoresis ; Exons ; Fibroblast Growth Factors* ; Fibroblasts* ; Humans ; Introns ; Polymerase Chain Reaction ; Receptor, Fibroblast Growth Factor, Type 3* ; Receptors, Fibroblast Growth Factor* ; Sequence Analysis, DNA

The C749G(Pro250Arg) mutation in the gene for fibroblast growth factor receptor 3 (FGFR3) has been found in patients with various types of craniosynostosis. In this study, the blood of 9 Korean children with non-syndromic craniosynostosis were collected and mutation analyses were performed to screen whether this Pro250Arg mutation is also prevalent in Korean population. The genomic DNA samples were analysed by PCR amplification to amplify exon 7 and flanking intron sequence of FGFR3 (341 bp). Restriction digests were analysed by gel electrophoresis. There were no heterozygous for Pro250Arg mutation. No mutations in restriction enzyme digestion were confirmed by direct DNA sequencing. In this study, only 9 patients with simple craniosynostosis were subjected to mutation detection. Therefore, it is necessary to study a large number of patients in order to understand the proportion of non-syndromic craniosynostosis attributalbe to FGFR3 mutation. The epidemiologic study of this disease should be also combined in addition.
Child ; Craniosynostoses* ; Digestion ; DNA ; Electrophoresis ; Exons ; Fibroblast Growth Factors* ; Fibroblasts* ; Humans ; Introns ; Polymerase Chain Reaction ; Receptor, Fibroblast Growth Factor, Type 3* ; Receptors, Fibroblast Growth Factor* ; Sequence Analysis, DNA

This report presents a case of fourth ventricle neurenteric cyst (NE cyst) mimicking hemangioblastoma, which developed in a 50-year-old woman. A tiny enhancing mural portion of the fourth ventricle in MRI suggested that the cyst was hemangioblastoma, but pathological evidence showed that the cyst was in fact NE cyst in the fourth ventricle. In order to make proper decision on to what extent of surgical resection should be done, considering every possibility in differential diagnosis might be helpful. This case reports an unusual pathology in 4th ventricle, considering the patient's age, and demonstrates that a rarer disease may share radiological features of a common disease.
Diagnosis, Differential ; Female ; Fourth Ventricle* ; Hemangioblastoma* ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Neural Tube Defects* ; Pathology

BACKGROUND: There have been various reports in the literature regarding the conservative management of pituitary apoplexy, pituitary incidentalomas and Rathke cleft cysts (RCCs). However, to the best of our knowledge, spontaneous involution of cystic sellar mass has rarely been reported. We report 14 cases of cystic sellar masses with spontaneous involution. METHODS: A total of 14 patients with spontaneous regression of cystic sellar masses in our hospital were included. The median age was 35 years (range, 5–67), and 8 patients were male. Clinical symptoms, hormone study and MRI were evaluated for all patients. The initial MRI showed all 14 patients with RCCs. Eight patients were presented with sudden onset of headache, and 1 patient with dizziness. Another patient, a 5-year-old child, was presented with delayed growth. Three patients had no symptoms via regular medical work up. All 14 patients had no visual symptoms. The follow-up period ranged from 5.7 to 42.8 months, with the mean of 17.3 months. RESULTS: The mean initial tumor size was 1.29 cm³ (range, 0.05 to 3.23). After involution, the tumor size decreased to 0.23 cm³ (range, 0 to 0.68) without any treatments. Repeated MRI showed a spontaneous decrease in tumor volume by 78% (range, 34 to 99). The initial MRI showed that the tumor was in contact with the optic chiasm in 7 patients, while compressing on the optic chiasm in 3 patients. Five patients were initially treated with hormone replacement therapy due to hormone abnormality. After the follow-up period, only 2 patients needed a long-term hormone replacement therapy. CONCLUSION: The spontaneous involution of RCCs is not well quantified before. Their incidence has not been well demonstrated, but this phenomenon might be underreported. Conservative management can be a treatment option in some RCCs without visual symptoms, even in those that are large in size and in contact with the optic nerve via imaging study.
Central Nervous System Cysts ; Child ; Child, Preschool ; Dizziness ; Follow-Up Studies ; Headache ; Hormone Replacement Therapy ; Humans ; Incidence ; Magnetic Resonance Imaging ; Male ; Optic Chiasm ; Optic Nerve ; Pituitary Apoplexy ; Tumor Burden